Full Text PA-95-022 DRUG ABUSE HEALTH SERVICES RESEARCH AND HIV/AIDS NIH GUIDE, Volume 24, Number 2, January 20, 1995 PA NUMBER: PA-95-022 P.T. Keywords: National Institute on Drug Abuse PURPOSE This Program Announcement will support a program of research on health services to drug abusers at high risk for HIV/AIDS at the client, program, and service system level. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of Healthy People 2000, a PHS-led national activity for setting priority areas. This PA, Drug Abuse Health Services Research, is related to the priority area of alcohol and other drugs. Potential applicants may obtain a copy of Healthy People 2000 (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by for-profit and non-profit, public and private organizations such as universities, colleges, hospitals, units of State and local governments, and eligible agencies of the Federal government. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as principal investigators. Foreign institutions are not eligible for First Independent Research Support and Transition (FIRST) Awards (R29). MECHANISM OF SUPPORT This program announcement will use the National Institutes of Health (NIH) individual research grant (R01), interactive research project grant (IRPG), small grant (R03), and FIRST award (R29). For further information on the IRPG mechanism refer to PA-94-086, NIH Guide for Grants and Contracts, Vol. 24, No. 28, July 29, 1994. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. RESEARCH OBJECTIVES Organizations providing drug abuse services have undergone rapid and complex changes over the past decade, both in response to the AIDS epidemic and larger changes in health care in the United States. The range of drug abuse services has expanded with the identification of drug-related problems (e.g., HIV infection, psychiatric co-morbidity, complications of pregnancy) and growing needs to intervene earlier and in a variety of settings. At the same time, the available drug abuse treatment modalities have evolved in the direction of becoming more diversified, providing a wider range of services, and forming linkages with the traditional health care establishment. In addition, new modalities and patterns of ownership (e.g., private, chemical dependency programs) and financial status (for-profit and not-for-profit) have emerged and thus a "two tier" system has resulted. More than one-third of the cases of AIDS have resulted from behaviors associated with drug abuse, such as needle sharing, drug-related prostitution, and sexual contact with infected drug abusers. There is a pressing need, therefore, to prevent the transmission of HIV in drug-related populations, provide accessible and appropriate services to infected drug abusers, and better understand how the service system can meet more of the needs of at-risk and infected populations. Achieving these goals is made more difficult, however, by formidable obstacles, that include gaps in services financing; fragmentation of services; limitations on eligibility, access, and utilization; the chronicity of drug abuse and dependence; and the reluctance of many drug abusers to enter treatment. Inducing behavior change, which is the only strategy currently available to prevent HIV infection among drug abusers, is a central goal of drug abuse treatment, as well as interventions outside treatment settings. NIDA's community-based research indicates that a large percentage of injecting drug users have never enrolled in drug abuse treatment programs. For many drug abusers, primary and critical care (including emergency room episodes, and primary care contacts within the criminal justice system) is their only contact with health care providers. Thus, a comprehensive approach to preventing transmission of HIV infection must include intervention in a variety of settings, including primary care, the community at large, and in drug abuse treatment programs and systems. This Program Announcement invites applications to study how drug abuse and other health services and service systems affect the prevention and management of HIV/AIDS in drug-abusing populations. Of special interest to NIDA are applications that focus on how the financing, organization, and management of drug abuse services affect access to and utilization, cost, quality, and outcomes of those services for high-risk or HIV-infected persons. High-risk persons include those whose drug abuse (especially intravenous use and the sharing of syringes) or drug-related sexual behaviors (including prostitution and other sex-for-drug exchanges) increase their risk of becoming infected or infecting others. Health services research proposals may include studies of systems, programs, or clients. They may address risk-reduction interventions in primary care settings or in drug abuse treatment programs. They may also focus on linkages between primary care and drug abuse treatment and on the delivery of services in non-traditional or community settings. In addition, applications may include studies of the role of services in reducing or preventing the transmission of HIV infection from drug abusers to sexual partners, or to the infants of drug abusers. Service and client outcome measures must include those relevant to HIV behavioral risk factors (such as needle sharing and unprotected sex), and to the utilization of HIV and AIDS services, such as AIDS counseling. Service system research may address the financing, organization, management, access and utilization of drug abuse treatment and other AIDS-related services, the integration of HIV risk reduction strategies into programs and systems of care utilized by drug abusers, and the cost-effectiveness and cost-offsets of HIV prevention efforts provided by drug abuse treatment and other interventions. Research is also needed on the need, demand, utilization, effectiveness, and cost-effectiveness of HIV outreach and prevention efforts with specific subgroups in various settings. Research applications are encouraged in four major areas of health services research: (1) drug abuse treatment services focused at system, program, and or client level; (2) HIV prevention services for drug abusers and their sexual partners, in health care settings and elsewhere; (3) health services for high-risk drug abusers in primary care settings, including closer linkages between primary care and drug abuse treatment programs; and (4) service needs, access, and utilization by adolescents, minority cultures, women of childbearing age and their young children, and high-risk "bridge" populations, such as gay intravenous drug abusers and drug abusers engaged in prostitution. Research proposals that focus on research within these areas or that cut across areas are encouraged. Topics not mentioned are not necessarily excluded from consideration under this Program Announcement. Studies are encouraged on the following kinds of issues: o The effects of various financing strategies on access to and the costs, quality, and outcomes of care for high-risk drug abusers (e.g., effects of private insurance coverage, Medicaid waivers, block grants, fixed budgets, and various cost and utilization controls as a part of financing programs, as in managed care); o How various forms of long-term care (such as residential care and less intensive forms of stretched-out care) affect utilization of services, retention in services, relapse rates, costs, and long- term recovery processes for high-risk clients; o How client and program factors influence treatment-seeking behavior, costs, utilization, quality, effectiveness, relapse, and changes in AIDS risk behaviors; o Organization and management of specialized services to meet the multiple needs of HIV-positive drug abusers and to reduce the spread of infection; o Access, delivery, integration, and management of HIV prevention interventions to individuals both in and out of drug abuse treatment, including delivery to specific high-risk subgroups such as adolescents, sexual partners of HIV positives, those in the criminal justice system, and those with chronic medical or psychiatric problems; o Barriers to service access and utilization for specific high-risk client populations and HIV-positive clients, and strategies for overcoming these barriers; o Impact of specific cost and utilization control policies and strategies on outreach, service delivery, retention in care, and effectiveness for clients at differing levels of HIV risk; o How various models of case management can improve the continuity and integration of care, and control of costs; o Making HIV outreach and prevention services more effective and cost-effective for reducing risk behaviors; o Patterns of staffing, background, training, and experience of providers and AIDS outreach programs, in relation to service needs of high-risk clients; o Design, organization, and management of accessible and effective combinations of drug abuse and primary care services; o Service system models to improve the quality and effectiveness of drug abuse treatment services, including matching, referral, and other linkage processes; o Improvement of linkages and liaisons with external resources, including improvements in the management of information and access to service networks; o The impact of improved record keeping (e.g., via longitudinal records and improved exchange of client records among primary care and other practitioners) and confidentiality safeguards on the continuity, adequacy, appropriateness, quality, and outcomes of care; o How health care and other organizations receive, assimilate, and adopt or respond to knowledge about the treatment of high-risk drug abusers; o Development of alternative HIV antibody testing and reporting strategies to improve access and utilization of appropriate services; o Organization, financing, utilization, and delivery of effective cross-training for primary care providers and drug abuse treatment providers; o How identification of drug abuse and associated HIV risk factors and complications can be improved, in non-drug abuse treatment settings, such as sexually transmitted disease clinics or educational settings; o How client and patient engagement in and compliance with medical treatment programs and referrals can enhanced. o Methods for diffusing innovative clinical practices and management techniques to improve drug abuse treatment and other HIV prevention services, and to lower costs; and o New methodologies (in measurement, research designs, and analytic techniques) that hold promise for the study of HIV-related aspects of drug abuse services, including valid and reliable measures of high- risk behaviors, behavior change, and client needs. Applicants are advised to review existing information relevant to drug abuse health services research and to design studies using the most rigorous methodological and analytic designs feasible. Timely reporting of findings is emphasized. Applicants should be willing to participate in research coordination efforts to maximize the utility of the research, including review and dissemination activities. Where appropriate, investigators are encouraged to offer HIV testing and counseling in accordance with current guidelines to subjects identified during the course of the research as being at risk for HIV acquisition or transmission. In high risk populations, investigators are encouraged to assess the effects of new interventions on the acquisition and transmission of infectious diseases, including HIV. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their subpopulations must be included in all NIH supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This new policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43) and supersedes and strengthens the previous policies (Concerning the Inclusion of Women in Study Populations, and Concerning the Inclusion of Minorities in Study Populations) which have been in effect since 1990. The new policy contains some new provisions that are substantially different from the 1990 policies. All investigators proposing research involving human subjects should read the "NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical Research," which have been published in the Federal Register of March 28, 1994 (FR 59 14508-14513), and reprinted in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume 23, Number 11. Investigators may obtain copies from these sources or from the program staff or contact person listed under INQUIRIES. Program staff may also provide additional relevant information concerning the policy. APPLICATION PROCEDURES Applications are to be submitted on the grant application form PHS 398 (rev. 9/91) and will be accepted at the standard application deadlines as indicated in the application kit. The receipt dates for applications for AIDS-related research are found in the PHS 398 instructions. Application kits are available at most institutional offices of sponsored research and may be obtained from the Office of Grants Information, Division of Research Grants, NIH, Westwood Building, Room 449, Bethesda, MD 20892, telephone 301-710-0267. The title and number of this program announcement must be typed in Item 2a on the face page of the application. FIRST applications must include at least three sealed letters of reference attached to the face page of the original application. FIRST applications submitted without the required number of reference letters will be considered incomplete and will be returned without review. The completed original and five permanent, legible copies of the PHS 398 form must be delivered to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892** REVIEW CONSIDERATIONS Applications will be assigned on the basis of established PHS referral guidelines. Applications will be reviewed for scientific and technical merit by study sections of NIH in accordance with the standard NIH peer review procedures. Following scientific-technical review, the applications will receive a second-level review by the appropriate advisory council. Small grant applications do not receive a second level review. As part of the initial merit review, triage will be used by the initial review group in which applications will be determined to be competitive or non-competitive based on their scientific merit relative to other applications received in response to the program announcement. Applications judged to be non- competitive will be withdrawn from further consideration and the Principal Investigator and the official signing for the applicant organization will be notified. Review Criteria o scientific, technical, or medical significance and originality of proposed research; o appropriateness and adequacy of the experimental approach and methodology proposed to carry out the research; o qualifications and research experience of the Principal Investigator and staff, particularly, but not exclusively, in the area of proposed research; o availability of the resources necessary to perform the research; o appropriateness of the proposed budget and duration in relation to the proposed research; o Adequacy of plans to include both genders and minorities and their subgroups as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. The initial review group will also examine the provisions for the protection of human and animals subjects, and the safety of the research environment. AWARD CRITERIA Applications will compete for available funds with all other approved applications. The following will be considered in making funding decisions: quality of the proposed project as determined by peer review; availability of funds; adequacy of provisions for the protection of human subjects; and program priority. INQUIRIES Written and telephone inquiries are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Frank M. Tims, Ph.D. Services Research Branch National Institute on Drug Abuse 5600 Fishers Lane, Room 10A-30 Rockville, MD 20857 Telephone: (301) 443-4060 Email: FTIMS@AOADA.SSW.DHHS.GOV Direct inquiries regarding fiscal matters to: Gary Fleming Grants Management Branch National Institute on Drug Abuse 5600 Fishers Lane, Room 8A-54 Rockville, MD 20857 Telephone: (301) 443-6710 Email: GFLEMING@AOADA.SSW.DHHS.GOV AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.279. Awards are made under authorization of the Public Health Service Act, Section 301, and administered under PHS policies and Federal Regulations at Title 42 CFR 52 "Grants for Research Projects", Title 45 CFR Part 74 & 92, "Administration of Grants" and 45 CFR Part 46, "Protection of Human Subjects". Title 42 CFR Part 2, "Confidentiality of Alcohol and Drug Abuse Patient Records" may also be applicable to these awards. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Sections of the Code of Federal Regulations are available in booklet form from the U.S. Government Printing Office. Grants must be administered in accordance with the PHS Grants Policy Statement, (rev. 4/94), which may be available from your office of sponsored research. The Public Health Service strongly encourages all grant recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. .
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